Anil Sukumaran

Introduction: In this modern era of technology, Information and Communication Technology (ICT) has made a very big revolution. Telemedicine is an emerging concept in health care services in Kerala, its implementation has not been satisfactory and successful. It is cost effective and provides easy access to healthcare services for people anywhere and especially during pandemic situations like this. A study is required in the domain of awareness and skill of doctors to facilitate its adoption and implementation. There was an urgent need to devise means for patients to consult doctors during Coronavirus Disease 2019 (COVID-19) pandemic. Aim: To assess the level of awareness and skill among doctors practicing modern medicine during COVID-19 pandemic. Materials and Methods: A cross-sectional study was conducted among 535 modern medicine doctors of Kerala from June 2020 to May 2021, using a structured self-administered questionnaire designed for the study. The total scores of awareness an...

Background: Vaccines are simple and widely accepted as one of the most important medical strategy of modern world in the prevention of morbidity and mortality. In order to ensure the protective benefits of vaccines, it is essential that the vaccine coverage should reach between 80-100% of a population, with required coverage dependent on the concerned vaccine and the illness that it is designed to prevent. Vaccine hesitancy is defined as the reluctance to be vaccinated or have one's children vaccinated. In this study, we assess the attitude of parents towards childhood vaccinations and the prevalence of vaccine hesitancy among parents in a rural area in Thiruvananthapuram district.Methods: A cross-sectional study was carried out among parents of children below the age of 15 years, who are residents of a rural area in Thiruvananthapuram district. Data was collected using the parents’ attitude about childhood vaccination (PACV) survey, with the consent of the participants. The col...

Introduction: Mental health and well-being is as important as physical health during pregnancy. But the Coronavirus Disease 2019 (COVID-19) pandemic has caused more anxiety and stress among pregnant women. The augmented levels of anxiety and stress may have detrimental effects on antenatal women. Anxiety and depression in pregnancy can lead to adverse pregnancy outcomes like increased risk of abortions, preterm labour and even foetal deaths. Aim: To assess the anxiety and stress levels among pregnant women attending a tertiary care hospital in Thiruvananthapuram, Kerala during the COVID-19 pandemic and to determine the associated factors. Materials and Methods: A cross-sectional study was conducted among 348 pregnant women attending a tertiary care teaching hospital in Thiruvananthapuram District in Kerala during the period October and November 2020 using a validated tool, Pandemic Anxiety Stress Scale for pregnant women. Higher scores indicating higher perceived anxiety stress with...

Introduction: As the pandemic of COVID-19 stretches, its wings across the different parts of the world over the past few months, it is very likely that mental health problems increase, particularly among the health-care workers who have higher risk of exposure to the disease and also to sufferings of the people affected with the disease. Objective: To assess the prevalence and factors associated with depression, anxiety, and stress among health-care workers from Kerala during the COVID-19 pandemic. Materials and Methods: A cross-sectional study among 544 health-care workers from Kerala was conducted by a self-administered online questionnaire in Google Forms by chain referral sampling with Depression, Anxiety, and Stress Scale-21 scale during initial phase of the COVID-19 pandemic. The tests of significance used were Mann–Whitney U-tests and Kruskal–Wallis tests. Odds ratios and 95% confidence interval are estimated. Results: During the early pandemic period, 9.7% of health-care wor...

Background: The health issues and social problems associated with alcohol use are well known. This study seeks to identify the prevalence of alcohol consumption and dependence among alcohol users in a rural area of Trivandrum district. Objectives: To assess the prevalence of alcohol use among adults of Nellanad Panchayat, a rural area in Trivandrum, Kerala, to find out the interventions required among the alcohol users, and to identify persons with harmful and hazardous use of alcohol using AUDIT. Settings and Design: Cross-sectional study in Nellanad Panchayat, Trivandrum district, Kerala. Methods and Materials: A cross-sectional study was carried out among 1545 residents in Nellanad Panchayat, a rural area in Kerala, by interviewing adults with the help of a questionnaire. Data were analyzed using SPSS. Results: The overall prevalence of current alcohol use was 146 (9.5%). The prevalence among males was 143 (18.3%) and females was 3 (0.4%). ASSIST scores showed that 99 (50%) of ever users required health education, 74 (37.8%) required counseling, whereas 23 (11.7%) required de-addiction. Conclusions: Among males, the alcohol consumption is still as high as 18.3%. The most important factor affecting alcohol use is peer pressure. Health education is the most required intervention to reduce burden of alcohol use.

The total hemolytic complement activity (CH50) and its fractions C3 and C4 were determined in forty patients with chronic generalized periodontitis (CGP). The values were compared with an equal number of age and sex matched periodontally healthy controls. Total hemolytic complement activity was expressed as number of CH50 units per ml of blood, while C3 and C4 levels were assessed by radial immunodiffusion and expressed as mg%. The observations showed a significant increase in CH50, C3 and C4 levels in the sera of patients with CGP. The study reveals the role of complement system in the pathogenesis of chronic generalized periodontitis.

This article presents a case of gingival squamous cell carcinoma in a patient who was HIV positive but who had no history of pan chewing, smoking, alcohol consumption or nutritional deficiency. Investigations also revealed the presence of superimposed pseudomembranous candidiasis. The case reported reveals that squamous cell carcinoma of the gingiva may occur as an oral manifestation of AIDS.

SummaryObjectives of the study were to investigate the variability in yeast adhesion and cell‐surface‐hydrophobicity (CSH) during human immunodeficiency virus (HIV) disease progression, using a total of 60 sequential Candida albicans isolated from oral rinse samples of seven HIV‐infected individuals with (4) and without (3) clinical symptoms of oropharyngeal candidosis. Significant differences in the adhesion to buccal epithelial cells (BECs) during sequential visits were observed for all genetic isotypes in five of the seven individuals and three isotypes belonging to the sixth individual. A single isotype of patient HK1 and another of HK4 (genotype I) demonstrated significant variations in their CSH during sequential visits whereas no such differences were noted for the remaining genotypes. On Spearman correlation analysis an isotype from HK1 demonstrated a significant increased adherence to BECs and CSH during HIV disease progression whereas no such correlation was noted for the ...

A rare female human model of oral carcinoma (OC) who refrained from any type of tobacco and/or betel nut habits, belonged to an younger age group, had no pre-existing precancerous lesions in the oral cavity and who was exposed chronically to cashew nut oil, is presented. The role of genetic inherited influences, occupational and endocrine disturbances with racial factors in the causation of oral carcinoma is discussed. The significance of further studies at the genetic level, to rule out protooncogenic activation in the causation of oral cancer is summed up. The literature on the concept of oncogenesis is reviewed briefly.

A case of oral submucous fibrosis in a 12-year-old girl discusses its etiopathogenesis, clinical features, and histopathologic findings of the condition and highlights strong association of areca nut chewing as the potential factor in the etiology of this condition. Cessation of the areca nut chewing habit and submucosal administration of aqueous extract of healthy human placental extract (Placentrex) showed marked improvement of the condition. (Pediatr Dent 15:120-22, 1993).

The study was conducted to estimate the concentration of immunoglobulins in the saliva of diabetic and nondiabetic patients with periodontitis. The salivary immunoglobulins G, A and M (IgG, IgA, IgM) were determined in 50 patients with type II or noninsulin dependent diabetes mellitus (NIDDM) and 50 non diabetic patients with periodontitis. The values were compared with that of 50 age and sex matched controls. IgG, IgA were found to be significantly increased in diabetic patients with periodontitis, compared to nondiabetic patients and controls. Though an increase in IgM was found in diabetic patients it was not significant. The altered immune response observed may be due to the response to a greater antigenic challenge which in turn may be responsible for the increased incidence of periodontitis in diabetic patients. Further studies in this field may help to establish this association.

Lectins are a group of specific glycoproteins present in cells, particularly cell membrane. Recently, lectin binding studies have been used as a diagnostic as well as prognostic indicator of neoplasm's. Oral submucous fibrosis (OSMF) is a potential premalignant condition predominantly seen in Indian subcontinent. A comparison of expression of lectin binding was studied in normal tissue, OSMF cases and oral squamous cell carcinoma. The OSMF cases were grouped into early and advanced conditions as per the histopathologic criteria. Patterns of lectin binding observed with advanced OSMF cases were comparable with that of Oral squamous cell carcinoma. The role of lectin binding studies in assessing the malignant potential of a pre-malignant condition is discussed.

The management of chronic periodontal disease is beset with a numbers of diagnostic as well as therapeutic problems. Assessment of periodontal disease progression has been made mainly based on the conventional methods such as clinical parameters and radiographic interpretation. A high level interest in the development of diagnostic tests capable of detecting factors associated with progressing periodontal disease has continued in the past years. Recent research has shown evidence that certain microbial species and specific genetic and related factors are some strong indicators of susceptibility to severe periodontitis. Here an attempt is made to review the current trends and diagnostic tests used to assess the disease activity and predict its progression.

The aim of this study was to evaluate the effectiveness of e-PTFE titanium reinforced and Guidor membranes in the management of alveolar ridge deformities. Five beagle dogs were included in the study. Three through and through defects of the same size (12 x 5 x 5) were created in each animal, one on the right side and two defects 3-4 mm distant from each other on the left side. Guidor membrane was applied to the right defect, e-PTFE was applied to one of the left defects while the third defect served as control. Three, six and nine months following membrane placement, the dogs were euthanized and membranes with surrounding bone tissues harvested for histological analysis. Healing in each animal was uneventful with no clinical sign of inflammation. Histological evaluation indicated the defects covered with both membranes had significantly gained greater bone formation than the control defects. On the other hand, the control defects healed thin rim of bone mostly with a persistent cen...

"The ultimate goal of periodontal therapy includes not only the arrest of progressive periodontal disease but also the predictable - regeneration of the periodontium at the site of previous periodontal breakdown; i.e, the formation of new cementum, new periodontal ligamnt, and a new alveolar bone. The evidence available to date indicates that the most frequnet mode of wound healing following surgical therapy is the development of long junctional epithelium and connective tissue adhesion, which may give a good clinical result, but fails to satisfy the goal of reegeneration. For regeneration to occur, periodontal ligament fibers must be embedded in cementum that has formed on a previously diseased or denuded root surface. Event hough extensive research has been done using various chemical and biological agents for enhancing connective tissue adhesion to root surface, results of these studies showed conflicting results. The application of these agents in routine periodontal therapy is yet to be substantiated. There is tremendous scope for further research in this field. "

Gingival Crevicular Fluid (GCF) changes occur during orthodontic tooth movement and this could serve as a potential indicator to the response to active treatment. The objective of the study is to assess the changes in the GCF volume and the levels of Alkaline Phosphatase (ALP) during early phase of tooth movement. 20 patients requiring all first premolar extractions were selected and treated with conventional straight wire mechanotherapy. Canine retraction was done using Nitinol closed coil springs. Maxillary canine on one side acted as experimental site while the contralateral canine acted as control. GCF was collected from around the canines before initiation of retraction, 1 hour after initiating canine retraction, 1 day, 7 days, 14 days and 21 days. GCF volume and the ALP levels were estimated and compared with the control side. The results showed statistically significant changes in the GCF volume and ALP levels on the 7th, 14th and 21st days at the experimental sides. The peak...

Secretion of hydrolytic enzymes such as hemolysin is considered an important virulence attribute of the opportunistic pathogenic fungus Candida. It is known that Candida spp. isolated from HIV-infected patients produce copious hemolysins. As common antifungal agents may perturb the production of extracellular enzymes, we evaluated the effect of three antifungals nystatin, amphotericin B and fluconazole on the hemolytic activity of Candida albicans and Candida tropicalis isolates from HIV-infected individuals. The impact of antimycotics on hemolytic activity was assessed by a previously described in vitro plate assay, after exposing ten isolates each of C. albicans and C. tropicalis recovered from HIV-infected individuals to sub-minimum inhibitory concentrations (sub-MIC) of nystatin, amphotericin B and fluconazole. All Candida isolates showed a significant reduction in hemolytic activity. The reduction was highest for amphotericin B-exposed C. albicans and C. tropicalis followed by ...

The magnitude of HIV infection in the Asian region is increasing dramatically. Oral disease represents an important health problem for HIV-infected individuals, because of its diagnostic, prognostic and therapeutic implications. The documentation and reporting of HIV infection and AIDS in most of the Asian countries has been superficial. Though the epidemiology of HIV infection in Asia has been studied by many investigators, few attempts have been made to summarise the data and assess the magnitude of the problem, the mode of transmission, the spread of infection and clinical pattern of illness. A review of the literature shows that there is hardly any published data on oral manifestations of HIV infection or AIDS from the Asian region. However, some preliminary information is available on the type of lesion presenting in patients from India and Thailand. These observations suggest that oral manifestations are common in HIV-infected and AIDS patients. The pattern of occurrence of various lesions reported appears to show variation from those reports from other parts of the world, but no definitive conclusion can be drawn from these preliminary observations. Further epidemiological studies are necessary to substantiate the present understanding of the nature of oral lesions found in Asian countries.

The effects of tobacco smoking on the prevalence and severity of periodontal disease have been well documented. However, very few studies have assessed the effects of oral smokeless tobacco (ST) on the periodontium. Considering the widespread use of ST products globally, the effects of such products on the periodontal tissues may be important. The present study was performed to compare retrospectively the patterns of periodontal destruction among oral ST users and never-users with periodontitis. Data from 149 patients with periodontitis (60 ST users and 89 never-users) were compared for mean scores of probing depth, recession (REC) and clinical attachment loss (CAL) and the mean percentage of sites with different ranges of probing depth, REC and CAL. For full-mouth scores, mean REC and CAL were significantly higher in ST users than in never-users (p < 0.001 and p = 0.008, respectively). For different regions of the dentition, mean scores of REC were significantly higher among ST users than among never-users (p < 0.001 for all regions), and mean scores of CAL were significantly higher for ST users in mandibular (p < 0.001), buccal (p = 0.008), lingual (p = 0.022), anterior (p = 0.012) and molar (p = 0.009) sites. Generally, there were higher percentages of sites with shallow pockets (0-3 mm), REC of ≥ 1 mm and CAL of ≥ 3 mm in ST users than in never-users. However, only differences for REC categories were significant for all regions (p < 0.001). ST users had a significantly higher proportion of sites with CAL of ≥8 mm for full-mouth sites (p = 0.003), mandibular teeth (p < 0.001), buccal sites (p = 0.002), anterior teeth (p = 0.040) and molars (p = 0.007). ST users tend to have more severe REC and CAL and a greater proportion of sites with higher values of REC and CAL compared with never-users. The greatest increase in severity of CAL was found to be localized to sites on mandibular teeth, buccal surfaces, anteriors and molars, which may be a result of the retention of the ST product in the oral cavity.

"AITBS Publishers & Distributors (Regd.) (DENTAL PUBLISHERS) J-5/6, Krishna Nagar, Delhi -110051, India. Phone: 2460494,205 4798 Fax: 221 8401"

periodontal therapy: Is the patient compliance adequate? J Int Oral Health 2015;7(11):16-19. Abstract: Background: The preservation of periodontal health of the treated patient requires a positive maintenance program. Failure of compliance to supportive periodontal therapy (SPT) could lead to undiagnosed sites of disease recurrence and ultimately loss of teeth. The objective of the study was to determine the patterns in compliance to maintenance phase after surgical periodontal therapy in a periodontal practice. Furthermore to understand the reasons, for non-compliance or erratic compliance and to take positive measures to improve compliance to SPT. Materials and Methods: Cross-sectional study was carried out in the Department of Periodontology, Pushpagiri College of Dental Sciences. Data were collected from case records of patients who had undergone surgical periodontal procedures at the center. Compliance to SPT was recorded. Patients were categorized as compliant, non-compliant a...

Aim The goal of pre-surgical dental implant treatment planning is to position the optimum number and size of implant fixtures to achieve the best restorative results. The purpose of this article is to describe the use of radiographic imaging software to calibrate and measure anatomical landmarks to overcome inherent distortions associated with dental radiographs. The procedure along with its potential use as an adjunct to radiographic interpretation in routine clinical implant practice is presented. Background Diagnostic imaging is an essential component of implant treatment planning, and a variety of advanced imaging modalities have been recommended to assist the dentist in assessing potential sites for implants. Although technological advances have resulted in new imaging innovations for implant dentistry, dental radiography remains the most widely used tool for determining the quantity and quality of alveolar bone as it is a non-invasive procedure. However, the unreliable magnifi...

Bone tissue engineering put emphasis on fabrication three-dimensional biodegradable porous scaffolds that supporting bone regeneration and functional bone tissue formation. In the present work, we prepared novel 3D tripolymeric scaffolds of nanochitosan (NCS)/silk fibroin (SF)/hyaluronic acid (HA) ternary blends and demonstrating the synergistic effect of scaffolds and its use in tissue engineering applications. The physico-chemical characterization of the prepared scaffold was evaluated by FTIR, XRD and SEM studies. The FT-IR and XRD results confirmed the interfacial bonding interaction existing between polymers. SEM images showed good interconnected porous structure with rough surface morphology. The in vitro cytocompatibility tests carried out with osteoblast cells by the MTT assay demonstrated that the blended scaffold favors the early adhesion, growth and proliferation of preosteoblast MC3T3-E1 cells. The alizarin red assay indicated that the prepared scaffold can promote the o...

In the present work, a series of novel nanochitosan/cellulose acetate/polyethylene glycol (NCS/CA/PEG) blend flat sheet membranes were fabricated in different ratios (1:1:1, 1:1:2, 2:1:1, 2:1:2, 1:2:1, 2:2:1) in a polar solvent of N,N'-dimethylformamide (DMF) using the most popular phase inversion method. Nanochitosan was prepared by the ionotropic gelation method and its average particle size has been analyzed using Dynamic Light Scattering (DLS) method. The effect of blending of the three polymers was investigated using FTIR and XRD studies. FTIR results confirmed the formation of well-blended membranes and the XRD analysis revealed enhanced amorphous nature of the membrane ratio 2:1:2. DSC study was conducted to find out the thermal behavior of the blend membranes and the results clearly indicated good thermal stability and single glass transition temperature (Tg) of all the prepared membranes. Asymmetric nature and rough surface morphology was confirmed using SEM analysis. F...

Chitosan is one of the most abundant natural biopolymer after cellulose. Nanochitosan (NCS) was prepared from chitosan by ionic gelation method with sodium tripolyphosphate. Polyurethanes (PU) find wide range of applications as good materials for the concentration and removal of both organic and inorganic pollutants because of their high efficiency for sorption of various ionic and neutral materials. Polypropylene glycol (PPG) is a family of long chain polymers attached to a glycerine backbone. The present project deals with the aims in exploiting the positive behaviour of the three polymers by preparing a ternary blends of NCS/PU/PPG(1:1:1) ratio. Batch adsorption process was carried out using prepared ternary blend of various parameters influencing the Pb(II) adsorption such as initial concentration of the metal solutions, pH, agitation time and adsorbent concentrations have been studied. The characterization of the prepared sample was carried out using FTIR, XRD, TGA, DSC and SEM...

Oral lesions in neonates represent a wide range of diseases often creating apprehension and anxiety among parents. Early examination and prompt diagnosis can aid in prudent management and serve as baseline against the future course of the disease. The present review aims to enlist and describe the diagnostic features of commonly encountered oral lesions in neonates. How to cite this article: Patil S, Rao RS, Majumdar B, Jafer M, Maralingannavar M, Sukumaran A. Oral Lesions in Neonates. Int J Clin Pediatr Dent 2016;9(2):131-138.

Drug Delivery Systems in Bone Regeneration and Implant Dentistry

Sukumaran Anil1, Asala F. Al-Sulaimani2, Ansar E. Beeran3, Elna P. Chalisserry4, Harikrishna P.R. Varma3 and Mohammad D. Al Amri5
[1] Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
[2] King Saud University, Riyadh, Saudi Arabia
[3] Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Poojappura, India
[4] College of Dentistry, King Saud University, Riyadh, Saudi Arabia
[5] Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia

Periodontal Needs of' Developing Nations
Editors: Angela R C Pack and Hubert N Newman
© 1996 International Academy cf Fteriodontdogy
ISBN 0-905927-89-3
100 pages, soft cover, 240 x 160mm

Available from the publishers:
Science Reviews Ltd.
41-43 Green Lane, Northwood,
Middx, HA6 3AE, ENGLAND

Surely, one of the great enigmas of dentistry is periodontal disease, or more correctly, "are the periodontal diseases".
Epidemiology consistently shows that most people (variously estimated at 90% of the population) have some form of periodontal disease for life. With our modern knowledge of the histopathology and means of management and prevention of periodontal diseases, it is a fact that many people (even dentists) know what they should be doing to overcome the problem, but still accept the presence of these diseases as a normal occurrence. This is the real enigma.
"Periodontal Needs of Developing Nations" edited by Angela R.C. Pack and Hubert N. Newman presents a series of papers from a symposium organised by the International Academy of Periodontology on 4th June 1995. This 86 page collection of nine papers provides an overview, not only of the problems and avenues for improvement in periodontal health in three areas of developing nations, but also some very perceptive comments on current knowledge of periodontal disease, the way in which international organisations can work, and a look to the future.
There is a message in this book for all of dentistry, national associations, public health, international dental organisations, and especially for individual providers of oral health care be they general practitioners, specialists, hygienists or other auxiliaries. The disease is the same whether the person is in a western or developing country - only the opportunity for care differs.
The introduction to the book sets the origin of this Symposium, the role of the International Academy of Periodontology, and provides a necessary and easy to follow review of the way this group works within the international dental community.
Dr Miyazaki presents the global overview of periodontal diseases with particular reference to the WHO data base. CPITN has provided most of the information, with a comment on the need to continue work on this index. Dr Miyazaki reflects on poor oral hygiene as an "all" country problem, but on the higher than usual level of calculus recorded in developing countries. The prevalence of severe disease for age is noted as 5-15% internationally whether in developing or industrial countries.
The next three chapters cover the lectures from Dr Lembariti, Tanzania; Dr Anil, India; and Dr Songpaisan, Thailand, looking at the problems as they exist in the African Continent, the Indian Sub-continent, and in South East Asian countries. For the reader these first papers give an excellent overview of the conditions for living in these areas, provide an interesting comparison of the populations, circumstances, lifestyles, directions, and also some well prepared statistics. Too often we talk about developing nations as if they are all the same. Nothing could be further from the truth and problems and lifestyles in Africa, India, and the countries that make up South East Asia are so different. The way that health services operate in these countries and the resources allocated in health through to the management of periodontal diseases are clearly demonstrated by these three
lecturers who are practitioners and workers in the dental public health field in their respective counties. The difficulties of living, expanding populations, fragile economies and priorities in health care put the allocation of scarce resources into prespective.
The following section provides detail of the periodontal needs in each area, what can be done, what is being done with some interesting examples. The theoretical overview for the management of periodontal disease is related to their own specific regional problems.
Dr Lembariti says "provision of expensive oral health services to reach the majority of the African population is unaffordable. The best alternative for Africa is the adoption of the primary' healthcare approach, that aims at improving efficiency, by using a few trained personnel.... the joint participation of all organs (governments, ministries, professional bodies, donors etc) and individuals involved in health promotion are crucial".
Dr Anil notes the organisations and structures that are already in place in India and how inadequate they are in terms of the size of the population and the distribution throughout this huge sub-continent. He rightly sees the need for an integrated plan of action if there is going to be some significant change made.
Dr Songpaisan has the difficult task of commenting on the wide range of countries in South East Asian regarded as developing. Reference is particularly made to the Changmai WHO programmes begun in 1985 which looked at the standard approach beginning with village scalers and moving through the step system where resources were available to the more professional qualified periodontal treatment systems.
Clearly identifying goals and the linkage of these to resources in health systems and managed programmes are a priority for all the regions.
The role of international aid organisations is demonstrated by the Aide Odontologique Internationale which is a French based organisation. Ten years of experience of dental care development in close collaboration with partners in developing countries is described. There are some very interesting examples of work in Rumania, Niger, Vietnam, and Mali, and the way to analyse needs and link this in to available aid systems. The most important need of working with local organisations rather than applying international ideas from remote locations is emphasised.
Dr Angela Pack, in the last chapter looks to the future of periodontal needs for developing countries. This very perceptive section begins with the need to rationalise and explain the data more effectively. The limitations of CPITN, an index that has served dentistry well, is particularly evident in severe disease changes and in planning and evaluating outcomes.
The FDI "step" programme in Guidelines to Community Care, provides a model for developing countries to best utilise their resources for a whole population while not ignoring the individual needs of people with severe destructive periodontal diseases who may seek special care. Dr Pack has concluded her paper and the Symposium by applying the WHO Report of 1994 on Oral Health for the 21st Century to the periodontal health needs for developing nations. Nine principles range from the need to rationalise resources through research, management, analysis of needs, setting of goals, and the training of personnel to provide care at whatever level the country is able to provide. The need for professional organisations, (if in existence in developing countries), to play their part in the overall management of periodontal diseases is essential.
Drs Pack and Newman have planned and produced an excellent overview of problems in dealing with periodontal disease in developing countries. It is well constructed, excellently written, and has well referenced text with relevance to all who work in the delivery of health services and dental care.
No dentists are more passionate or enthusiastic about their work than periodontists and those who work in public health of periodontics. Over the past fifteen years I have met all the speakers, listened to them talk, and heard of their frustrations in trying to improve the oral health of their communities, and of trying to interest governments, national associations, and international bodies to help. Yet through all this they never seem to lose their optimism. Those who have contributed to this Symposium are dedicated researchers, clinicians, and public health workers. Dentists throughout the world and particularly in New Zealand would learn much from reading this book, both for the problems encountered in developing countries and continents, and in the management of periodontal disease in general.
In New Zealand we have a high level of periodontal disease, most of it a low threat to the life of the teeth, but nonetheless it is a "blot" on our health landscape that we accept periodontal disease as endemic. None of the people who have
written this book and made presentations are looking for instant change in the periodontal health of the world. They are working for small gains. Every person who improves their oral hygiene by whatever means, reduces the problems they may encounter with more severe disease. As Dr Lembariti notes, a difficult life-style can seem surprisingly easier with improvement in oral health.
This book on Periodontal Needs of Developing Nations, edited by Drs Pack and Newman, from a Symposium organised by the Internationa] Academy of Periodontology under the sponsorship of Sunstar, Japan, Dumex and Stafford Miller, and the publication sponsored by Unilever Dental Research, UK, is to be commended to all who follow the progress of the management of periodontal disease in whatever country.
Lawrence J. Croxson
Executive Director NZDA
Auckland
July 1996

Periodontal Needs of Developing Nations

Editors: Angela R C Pack and Hubert N Newman
© 1996 International Academy cf Fteriodontdogy
ISBN 0-905927-89-3
100 pages, soft cover, 240 x 160mm

Available from the publishers:
Science Reviews Ltd.
41-43 Green Lane, Northwood,
Middx, HA6 3AE, ENGLAND

Surely, one of the great enigmas of dentistry is periodontal disease, or more correctly, "are the periodontal diseases".
Epidemiology consistently shows that most people (variously estimated at 90% of the population) have some form of periodontal disease for life. With our modern knowledge of the histopathology and means of management and prevention of periodontal diseases, it is a fact that many people (even dentists) know what they should be doing to overcome the problem, but still accept the presence of these diseases as a normal occurrence. This is the real enigma.
"Periodontal Needs of Developing Nations" edited by Angela R.C. Pack and Hubert N. Newman presents a series of papers from a symposium organised by the International Academy of Periodontology on 4th June 1995. This 86 page collection of nine papers provides an overview, not only of the problems and avenues for improvement in periodontal health in three areas of developing nations, but also some very perceptive comments on current knowledge of periodontal disease, the way in which international organisations can work, and a look to the future.
There is a message in this book for all of dentistry, national associations, public health, international dental organisations, and especially for individual providers of oral health care be they general practitioners, specialists, hygienists or other auxiliaries. The disease is the same whether the person is in a western or developing country - only the opportunity for care differs.
The introduction to the book sets the origin of this Symposium, the role of the International Academy of Periodontology, and provides a necessary and easy to follow review of the way this group works within the international dental community.
Dr Miyazaki presents the global overview of periodontal diseases with particular reference to the WHO data base. CPITN has provided most of the information, with a comment on the need to continue work on this index. Dr Miyazaki reflects on poor oral hygiene as an "all" country problem, but on the higher than usual level of calculus recorded in developing countries. The prevalence of severe disease for age is noted as 5-15% internationally whether in developing or industrial countries.
The next three chapters cover the lectures from Dr Lembariti, Tanzania; Dr Anil, India; and Dr Songpaisan, Thailand, looking at the problems as they exist in the African Continent, the Indian Sub-continent, and in South East Asian countries. For the reader these first papers give an excellent overview of the conditions for living in these areas, provide an interesting comparison of the populations, circumstances, lifestyles, directions, and also some well prepared statistics. Too often we talk about developing nations as if they are all the same. Nothing could be further from the truth and problems and lifestyles in Africa, India, and the countries that make up South East Asia are so different. The way that health services operate in these countries and the resources allocated in health through to the management of periodontal diseases are clearly demonstrated by these three
lecturers who are practitioners and workers in the dental public health field in their respective counties. The difficulties of living, expanding populations, fragile economies and priorities in health care put the allocation of scarce resources into prespective.
The following section provides detail of the periodontal needs in each area, what can be done, what is being done with some interesting examples. The theoretical overview for the management of periodontal disease is related to their own specific regional problems.
Dr Lembariti says "provision of expensive oral health services to reach the majority of the African population is unaffordable. The best alternative for Africa is the adoption of the primary' healthcare approach, that aims at improving efficiency, by using a few trained personnel.... the joint participation of all organs (governments, ministries, professional bodies, donors etc) and individuals involved in health promotion are crucial".
Dr Anil notes the organisations and structures that are already in place in India and how inadequate they are in terms of the size of the population and the distribution throughout this huge sub-continent. He rightly sees the need for an integrated plan of action if there is going to be some significant change made.
Dr Songpaisan has the difficult task of commenting on the wide range of countries in South East Asian regarded as developing. Reference is particularly made to the Changmai WHO programmes begun in 1985 which looked at the standard approach beginning with village scalers and moving through the step system where resources were available to the more professional qualified periodontal treatment systems.
Clearly identifying goals and the linkage of these to resources in health systems and managed programmes are a priority for all the regions.
The role of international aid organisations is demonstrated by the Aide Odontologique Internationale which is a French based organisation. Ten years of experience of dental care development in close collaboration with partners in developing countries is described. There are some very interesting examples of work in Rumania, Niger, Vietnam, and Mali, and the way to analyse needs and link this in to available aid systems. The most important need of working with local organisations rather than applying international ideas from remote locations is emphasised.
Dr Angela Pack, in the last chapter looks to the future of periodontal needs for developing countries. This very perceptive section begins with the need to rationalise and explain the data more effectively. The limitations of CPITN, an index that has served dentistry well, is particularly evident in severe disease changes and in planning and evaluating outcomes.
The FDI "step" programme in Guidelines to Community Care, provides a model for developing countries to best utilise their resources for a whole population while not ignoring the individual needs of people with severe destructive periodontal diseases who may seek special care. Dr Pack has concluded her paper and the Symposium by applying the WHO Report of 1994 on Oral Health for the 21st Century to the periodontal health needs for developing nations. Nine principles range from the need to rationalise resources through research, management, analysis of needs, setting of goals, and the training of personnel to provide care at whatever level the country is able to provide. The need for professional organisations, (if in existence in developing countries), to play their part in the overall management of periodontal diseases is essential.
Drs Pack and Newman have planned and produced an excellent overview of problems in dealing with periodontal disease in developing countries. It is well constructed, excellently written, and has well referenced text with relevance to all who work in the delivery of health services and dental care.
No dentists are more passionate or enthusiastic about their work than periodontists and those who work in public health of periodontics. Over the past fifteen years I have met all the speakers, listened to them talk, and heard of their frustrations in trying to improve the oral health of their communities, and of trying to interest governments, national associations, and international bodies to help. Yet through all this they never seem to lose their optimism. Those who have contributed to this Symposium are dedicated researchers, clinicians, and public health workers. Dentists throughout the world and particularly in New Zealand would learn much from reading this book, both for the problems encountered in developing countries and continents, and in the management of periodontal disease in general.
In New Zealand we have a high level of periodontal disease, most of it a low threat to the life of the teeth, but nonetheless it is a "blot" on our health landscape that we accept periodontal disease as endemic. None of the people who have
written this book and made presentations are looking for instant change in the periodontal health of the world. They are working for small gains. Every person who improves their oral hygiene by whatever means, reduces the problems they may encounter with more severe disease. As Dr Lembariti notes, a difficult life-style can seem surprisingly easier with improvement in oral health.
This book on Periodontal Needs of Developing Nations, edited by Drs Pack and Newman, from a Symposium organised by the Internationa] Academy of Periodontology under the sponsorship of Sunstar, Japan, Dumex and Stafford Miller, and the publication sponsored by Unilever Dental Research, UK, is to be commended to all who follow the progress of the management of periodontal disease in whatever country.
Lawrence J. Croxson
Executive Director NZDA
Auckland
July 1996